Mental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral PalsyMental Health and Coping Strategies Among Caregivers of Children with Cerebral Palsy
VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF EDUCATION NGUYEN THI MAI HIEN MENTAL HEALTH AND COPING STRATEGIES AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY DOCTORAL DISSERTATION IN CLINICAL PSYCHOLOGY Code: 9310401.01 HANOI - 2023 VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF EDUCATION NGUYEN THI MAI HIEN MENTAL HEALTH AND COPING STRATEGIES AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY DOCTORAL DISSERTATION IN PSYCHOLOGY Major: Children and Adolescent Clinical Psychology Code: 9310401.01 Supervised by: Prof Bahr Weiss Assoc Prof Tran Van Cong Ph.D CANDIDATE SUPERVISORS UNIVERSITY OF EDUCATION HANOI - 2023 i DECLARATION I, the undersigned, hereby declare that this thesis “Mental Health and Coping Strategies Among Caregivers of Children with Cerebral Palsy” is entirely my work without plagiarism All information sources used in this dissertation have been acknowledged and its authors have been referenced This research was only submitted to the University of Education, Vietnam National University, Hanoi under the framework of the Children and Adolescent Clinical Psychology Doctoral Training Program Name: Nguyen Thi Mai Hien ii ACKNOWLEDGEMENTS I would like to express my deep gratitude to all who have contributed to the development of this dissertation Wholehearted thanks are given to my mentors and advisors, Professor Bahr Weiss, and Associate Professor Tran Van Cong for their fruitful guidance in shaping the conceptual framework, developing research tools, data analysis, thesis writing, and upholding At some point in time, I lost motivation, felt down, and wanted to give up, my Ph.D programmate, Ho Thu Ha, gave hands to me with great empathy She authentically shared her experiences in doing research Thus, I step by step regain the energy and interest in moving the research forward There are not enough words to express my appreciation for her support It would not be possible for me to complete this work without the precious collaboration of the Cerebral Palsy Family Association of Vietnam My sincere thanks go to the chairperson, Ms Dinh Thi Lan Anh, her staff, Ms Nguyen Thu Hong, and more than 300 of its members who have joined hands with the research tool development, and data collection process I also want to convey thanks to the Vietnam Psychotherapy Association where I have been working for more than years, its members, volunteers, and people at the University of Education, Vietnam National University for enabling and assisting me on my pathway to complete the research My family without whom I would never have had the courage and goodwill to go through many challenges and complete this long process My husband Hoang Quoc Dung, my son Hoang Quoc Phong, and my daughter Hoang Thi Mai Nuong have shown their patience, their love, and their being on my side to accept any version of myself I am lucky to have them in my life Although I cannot name all persons to whom I owe a debt of gratitude for their support, I hope that they understand my true respect for them iii LIST OF ABBREVIATIONS CDS : Caregiver Difficulties Scale COPE : Coping Orientation to Problems Experienced CP : Cerebral Palsy CPFAV : Cerebral Palsy Family Association Vietnam CWD : Children with Disabilities GSO : General Statistics Office GMFCS : Gross Motor Function Classification System GAD-7 : Generalized Anxiety Disorder-7 MoH : Ministry of Health PHQ-9 : Patient Health Questionnaires- PWD : People with Disabilities QoL : Quality of Life CRPD : United Nations’ Convention on the Rights of Persons with Disability UNICEF : United Nations International Children's Emergency Fund WHO : World Health Organization iv TABLES OF CONTENTS DECLARATION i ACKNOWLEDGEMENTS ii LIST OF ABBREVIATIONS iii TABLES OF CONTENTS iv LIST OF TABLES vi LIST OF FIGURES viii INTRODUCTION 1 Rationales Objectives of the study 3 Research questions 4 Research design 5 Scope of the research Contribution of the thesis CHAPTER THEORETICAL BASIS 1.1 Literature review on mental health and coping strategies 1.1.1 Overview of the research on mental health 1.1.2 Overview of the research on coping strategies .18 1.1.3 Factors associated with mental health and coping strategies among caregivers of children with CP .22 1.1.4 Research on the intervention to support caregivers to improve mental health… 31 1.2 Theoretical framework 36 1.2.1 Key concepts .35 1.2.2 The underlying theoretical models 51 CHAPTER METHODOLOGY .62 2.1 Research design 62 2.2 Research procedures 63 2.3 Research samples 68 2.3.1 Research sites 68 v 2.3.2 Samples .69 2.4 Research measures 75 2.4.1 Measurement of mental health among caregivers of children with CP 75 2.4.2 Measurement of coping strategies used by caregivers of children with CP 78 2.4.3 Measurement of associated factors to mental health 82 2.5 Statistical analyses 85 2.6 Ethical considerations 87 CHAPTER RESULTS .89 3.1 The mental health status of the studied caregivers of children with CP 89 3.1.1 Prevalence of depression, anxiety, and quality of life 89 3.1.2 Differences in depression, anxiety, and quality of life among caregivers by demographic characteristics 93 3.2 Coping strategies among caregivers of children with CP .101 3.2.1 The coping strategies used by caregivers of children with CP 101 3.2.2 The aspects associated with coping strategies used by caregivers .103 3.3 The factors associated with the mental health status of the caregivers 112 3.3.1 Correlation among depression, anxiety, and quality of life .112 3.3.2 Factors associated with depression of caregivers .113 3.3.3 Factors associated with anxiety of caregivers 126 3.3.4 Key factors associated with the quality of life (QoL) of caregivers 139 CHAPTER DISCUSSION .151 3.4.1 Mental health status among caregivers of children with CP 151 3.4.2 Coping strategies used by caregivers of children with CP 158 3.4.3 Factors associated with identified mental health of the caregivers 167 CONCLUSION 180 LIST OF RESEARCH PAPERS RELATED TO THE DISSERTATION 184 REFERENCES 185 APPENDICES 209 vi LIST OF TABLES Table 1.1: Summary of factors associated with mental health among caregivers of children with disabilities 27 Table 2.1: List of provinces having caregivers joining the study 68 Table 2.2: Age, ethnicity, religion, and marital status among primary caregivers 69 Table 2.3: Education and occupation of primary caregivers 71 Table 2.4 Caregiving responsibilities 72 Table 2.5 Socio-economic conditions of the caregivers’ families 73 Table 2.6: Characteristics of the child with CP 74 Table 3.1 Percentage of caregivers with depression and the level of severity 89 Table 3.2 Percentage of caregivers with anxiety and the level of severity 90 Table 3.3: Caregivers with both depression and anxiety 92 Table 3.4: Caregiver's quality of life by items .92 Table 3.5 Mean scores of depression, anxiety, and QoL by localities 93 Table 3.6 Mean scores of depression, anxiety, and QoL by family conditions .95 Table 3.7 Mean scores of depression, anxiety, and QoL by 96 CP children’s features 96 Table 3.8 Mean scores of depression, anxiety, and QoL by social support 97 Table 3.9 The rate of caregivers reporting reasons for their emotional problems 99 Table 3.10 Correlation among factors of coping 103 Table 3.11: Correlation between coping strategies and # years living with CP 107 Table 3.12: Correlation between coping strategies and functional impairments, independent living of CP children .108 Table 3.13: Correlation between coping strategies and family incomes 109 Table 3.14: Correlation between coping strategies and care responsibilities .109 Table 3.15: Correlation between coping strategies and burden of care 110 Table 3.16 Correlation among PHQ-9, GAD-7 and QoL 112 Table 3.17: Effects of different coping strategies on depression 113 Table 3.18: Effects of social support on caregivers’ depression 114 Table 3.19: Effects of the family’s support and incomes on depression 116 vii Table 3.20: Effects of care responsibilities on depression 117 Table 3.21 Effects of caregiving burden on depression 119 Table 3.22 Effects of CP child-related factors on depression .120 Table 3.23: Effects of interaction between coping strategies and risk factors on depression 122 Table 3.24: Interaction between social support and risk factors on depression 124 Table 3.25: Effects of different coping strategies on anxiety .126 Table 3.26: Effects of social support on caregivers’ anxiety .128 Table 3.27: Main effects of the family’s support and incomes on anxiety 130 Table 3.28: Effects of care responsibilities on anxiety 131 Table 3.29 Effects of caregiving burden on anxiety 132 Table 3.30 Effects of CP child-related factors on anxiety 133 Table 3.31: Effects of interaction between coping strategies and risk factors on anxiety 135 Table 3.32: Interaction between social support and risk factors on anxiety 136 Table 3.33: Effects of different coping strategies on QoL 140 Table 3.34: Effects of social support on caregivers’ QoL 141 Table 3.35: Main effects of the family’s support and incomes on QoL .142 Table 3.36: Effects of care responsibilities on QoL .143 Table 3.37 Effects of caregiving burden on QoL 144 Table 3.38 Effects of CP child-related factors on QoL .145 Table 3.39: Effects of interaction between coping strategies and risk factors on QoL 147 Table 3.40: Interaction between some social support and risk factors 149 viii LIST OF FIGURES Figure 1.1: Biopsychosocial Model .53 Figure 1.2: Theoretical model of stress, appraisal, and coping of 58 Larazuz and Folkman 58 Figure 1.3: Conceptual framework of mental health and associated factors among caregivers of children with CP 61 Figure 3.1 Percentage of caregivers by depression symptoms .90 Figure 3.2 Percentage of caregivers by anxiety symptoms 91 Figure 3.3 The four-factor coping strategies of caregivers 101 Figure 3.4 Frequency of coping strategies used by caregivers 102 Figure 3.5 Differences in coping strategies by region 103 Figure 3.6 Differences in coping strategies by rural/urban areas .104 Figure 3.7 Differences in coping by CP child’s motor function impairments .107 Figure 3.8 Differences in coping strategies by CP prognosis 108 Figure 3.9 Proposed diagram of mental health care applied by CPFAV 183